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PERMEpE APPLICATION <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />crt <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 <br />SITE ADPRESS PARCEL TAX I.D. # PERMIT # <br />��� <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT FOR. RMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE \%� <br />s v 3— <br />PROPOSED USE OF BUILDING <br />Build' Mechanical <br />p <br />Addition i <br />HEAT SOURCE <br />Electric <br />PERMIT <br />Combination �R(-'plumbing <br />'Mti <br />WORK <br />Alteration <br />Q <br />TYPE <br />�Ry <br />Demolition CJ Jign <br />TYPE <br />New <br />Gas <br />u Sprinkler <br />RepairlMaint. <br />U Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO, TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C -AIHANDLING UNITS <br />% <br />BATHTUB <br />_FORCED <br />AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />_HEAT <br />PUMP <br />_ <br />SHOWER <br />_UNIT <br />HEATERS <br />/ <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />Z <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />_FIREPLACE <br />INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_EXHAUST <br />FAN <br />_ <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING <br />THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOI.1 OF ANY OTHER <br />NOT. <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM17 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACT 18.27 CW AND 296.200 WAC. <br />nRS�LA/W� <br />// <br />tz <br />Si re of Owner/ ntractor/Autho ( d A gent Date <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED _ J <br />